Dr. Canady’s public health career reflects her longstanding commitment to address racism and promote health equity through research, health promotion interventions, and in her current role as Health Officer for the Ingham County Health Department in Michigan. Her commitment and courage in addressing racism as a root cause of health inequities, combined with her long history of collaborating with community partners and other public health organizations, make her an obvious public health hero to highlight. She has led initiatives to identify, acknowledge, and address the influence of racism on health department policies and procedures, which may contribute to racial and ethnic health disparities. Dr. Canady also serves as chair of the Health Equity and Social Justice board for the National Association of City and County Health Officers (NACCHO).

Career in Profile

1983 – Majored in zoology (B.S.) at University of North Carolina

1984 – Majored in public health (B.S.P.H.) at University of North Carolina

1984 – 1986 – Assistant Area Director, University of North Carolina, Department of Residential Life

There seems to be a social justice element in your work that doesn’t always come through in the work that others do in public health. Can you talk about your inspiration for social justice?

Interestingly, the history of public health – as a discipline and a field – was birthed out of social justice. We have many past accomplishments where public health played an integral role in policymaking, such as child labor laws, and other labor and workforce requirements like OSHA (Occupational Safety and Health Administration), health and safety for employees, the average work day. Since that time, we have gotten caught up in the categorical funding established by our federal government. Those are important, but in many ways, we have almost lost the creativity in how we do things that are vitally important to the health of our community, but don’t happen to have a categorical funding stream. That’s where I often say that health equity/social justice is not so much the what we do, but it’s the how and the why we do it.

So, we happen to be a local health department, which because of prior grants, relationships, and community engagements, is positioned to carry this banner to transform public health back to its social justice health equity roots. How do we stop dealing simplistically with the fact that infants are dying? From the perspective of this mom who’s pregnant today, how do we ensure that she is going to have a healthy outcome? By starting to deal with the context of that mom’s life before she even conceives! What’s happening in our community? What true accessibility do people have? What are we doing to make sure that there is an equitable distribution of the resources that people need to maintain their health and wellness? We know that right now we don’t have that. We know that there are communities, regions, sectors, hot spots – based upon the numerous ways that we geocode and map – that have higher rates of obesity and morbidity. We know that life expectancy varies based upon where you live. When we map life expectancy by zip code, we see differences between communities.

We have to be less short-sighted as public health professionals. We have to begin to look at the “causes of the causes.” That requires a social justice lens – a health equity lens. Margaret Whitehead has an important definition of health inequities. She describes them as being unfair, unjust, and actionable. Sometimes people say, ‘that’s just so big – I can’t do anything about poverty.’ No, we can do something about poverty! And we can certainly pool our social capital and access to policy makers. We have to tell our public health story differently. Otherwise, we’ll continue to get grants to educate pregnant moms about how to have a healthy pregnancy. That can continue on ad nauseum if we don’t also, while we’re working with those pregnant moms, deal with the structure of their lives, and talk to policymakers.

In our efforts at Ingham County Health Department, as related to health equity and social justice, we have the position ‘Coordinator of Health Equity and Social Justice’. We have the position ‘Environmental Justice Coordinator.’ Those titles are all very intentional. When I came on board six years ago, the Health Equity and Social Justice Coordinator had the title of ‘Access to Care Coordinator’, but I wanted to bring a broader, more comprehensive acknowledgement of his work (in this case, it was a ‘he’). We began to be very intentional about the words that we use. We wanted to shift the thinking within our local health department. At the same time, our regional and a national leader began to get public health re-engaged and re-empowered to address not just the social determinants of health, but the injustices that are found within the social determinants of health.

Which career highlights are you most proud of?

One accomplishment is my department’s implementation of a comprehensive workshop that addresses public health and health equity. We have done a lot of education and workshops, we use facilitated dialogue to learn about and then disseminate information regarding health equity and social justice. At this point, the majority of our staff have been through the workshop. Now, we are often asked, “What is the next step we should take?”

We believe that dialogue is action. It is a verb. People often ask, “Why are we just talking about this? Why don’t we do something?” Well, if you talk strategically and in a way that is designed to produce outcomes – which is the heart of dialogue – that is doing something. We’re looking at our next level of implementation. It’s a partnership between the community organizing field and the public health field. It thinks about how both sectors can wield power in a way that benefits both the constituents that public health serves, and the residents for whom community organizers advocate. We’re part of this national innovation because of our experience and reputation, and because I have been privileged to serve as the chair of the National Association of County and City Health Officials Health Equity and Social Justice Committee. And so the work continues!

I am especially proud of our successful grant writing. I remember, as a graduate student, learning about the Nurse-Family Partnership, which is an evidence-based model for reducing infant mortality and preterm deliveries among the most at-risk, vulnerable moms. We were successful in positioning our department to gain funding for this program this year. We are now in the process of implementing a Nurse-Family Partnership initiative. In addition, after three years, one resubmission, then twiddling our thumbs when the federal government did not offer any funding, and then a final successful re-submission, we were able to bring another federal initiative into this community, the Healthy Start Program, which also addresses infant mortality. I am grateful that we have brought a number of resources to the community. Our selection as a one of the few recipients of the Pew Charitable Foundation/Robert Wood Johnson grant to expand Health Impact Assessment is extremely gratifying. We do our work in community and with community, through a health equity lens. We look forward to seeing some changes in the trends and statistics for our community.

When it comes to public health, what matters to you and why?

I think partnership matters. I describe myself as a relationship-driven person. I believe that everything that we accomplish comes through and out of relationships. For example, I remember when we received word of two parallel opportunities: the IRS required local health systems to complete a community health assessment (to show community need for their services), and our department was notified about a national accreditation process through the Public Health Accrediting Board. Each called for community health assessments. As the local Health Officer, I could have easily done a local community health assessment. Similarly, our hospital partners are high capacity health systems – they could have done a community health assessment. But instead, we came together and cultivated a regional approach, seeking collective impact. It was not just my local health department, it was also two other local health departments in the tri-county region of Sparrow, Ingham, and Clinton. In that same spirit, we also included hospitals in that tri-county area – three primary hospitals, with additional contact with some other smaller community-based hospitals. We all came to the table to talk about how we might leverage this opportunity for greater synergy and a stronger product, based upon what each of us knew about our own regions, areas, and communities. Collaboration is not always easy, but it has absolutely been worth the extra effort. It led us to not just coming to a compromise, but coming to a place of agreement. That could not have been done without previously established relationships of trust, confidence and respect. Quite simply, I value the blessing and the benefit of relationships that support and facilitate the public health work that I am responsible for.

There is a quote by Richard David that says, “Relationships are primary. All else is derivative.” I have found that to be true. Everything that we do is a derivative of relationship. Our health department, and community at large, have a strong history of fruitful relationships. We enjoy partnering on numerous initiatives. I came from a university setting where you are socialized to accomplish a lot and get credit for a lot – write a lot, put your name on things. So it was an interesting adjustment to come to the health department, where our philosophy was to position our partners to get credit, instead of taking credit ourselves. When funding opportunities came up, we would write the grant, and we pushed the money out to the community. I was struck by that practice. “Wait a minute, aren’t we going to save some of this money to hire our own people to do this work?” The response from department leadership was, “The community knows better. They have a better pulse of what’s happening, so we’ll push it out to them.” It’s been a counter-intuitive but successful model for our public health interventions. It’s really exciting for me to think about continuing in that same vein.

What would you say are some of the most pressing public health challenges related to the work that you do?

Well, there are the epidemiological disease models that we continue to study, like infant mortality prevention, childhood obesity, diabetes – all of those chronic diseases, which are influenced both by personal responsibility, but also social responsibility and how we structure the lives of people. We know that our state and our nation underperforms in these areas. I think the biggest challenge for us in public health is to begin to think differently about our work, and to learn from the history of very insightful, intuitive, intelligent founders to resurrect some of those norms. How we value and measure prevention is a huge methodological question. How do we value prevention in public health, so that we can more equitably and effectively fund prevention in public health? It’s really easy to see the burning house and jump into action and say, “Oh, we’ve got to put that out right now!” But how do we value doing things to make sure that houses don’t catch fire at all? If you think about our bodies and our communities as houses, that’s a really big challenge. I think we’re at a real cusp in public health where we’ve got to figure that out. How do we elevate the science of public health? How do we design partnerships and systems that integrate public health and primary care? I continue to think about the future public health workforce, and how we really recruit and prepare people to advance this agenda aggressively, but perhaps differently than we have advanced it in the past.

The context with which we do our public health work will always vary. Our goal could be to fix the problem of obesity. In 10 years or a generation, we should not still be battling obesity at a secondary prevention level, but rather at a primary prevention level. We will likely be battling some other disease or problem that we may not even be able to name right now. How do we build the capacity to be diverse and to be responsive and adaptive to the current needs of our community? That is the strength of public health: it wields a skill set across differing contexts and circumstances.

How do we keep energy and passion at the table? It’s a wonderful field. I am also an adjunct professor at Michigan State University, and I spend a lot of time with students, trying to share the key to energy and purpose. This is very mission-driven work; believing in the mission brings passion and passion brings energy. Public Health is not a job where you clock in at 8am and clock out at 5pm. It stays with you. It confronts you as you drive home, it frames the way you watch television programs, and how you look at things when you’re in a restaurant or walking through a grocery store. That type of passion and energy will advance us towards becoming one of the healthiest nations in the world. Public health will always be needed because we’ve got a lot of work to do to get there.

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